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TMJ Disorder -TemporoMandibular Joint Message Board


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Old 05-26-2003, 04:23 PM   #1
Cymy Sue
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Question goodwillstacy.......Surgery?


How are you? I keep thinking about your post regarding your surgery and the Insurance only paying $2000. I am at a loss on this. I have had 2 Arthroplasties and they were paid 100%. The last one was 6 years ago, have things changed that much?

My Insurance states it will only pay $2000 for "Non-Surgical Treatment" of TMJD. $2000 is a joke for a surgery.

In your post, you did talk to your Ins Co. and not the Surgeon's Office, Right? Sometimes those office people get confused. Arthroplasties are Joint Surgeries, just like elbows, knees, etc.

I just don't understand how they can do this and I certainly don't see how "TMJD Surgeons" will stay in business if Insurance Companies can interject these clauses. I would think the Surgeons would be out on the street protesting. I don't know anyone who could come up with that kind of money. Anyway, I'm sorry that you've had to deal with this along with the fears of having surgery.

I noticed you haven't made a post in a while, I hope you're still with us. I know you read all kind of things and get all kinds of advice from different sources when you're considering surgery. Don't let some of this stuff get to you.

"Always" consider the source and remember your HB family is here for you.

Cymy Sue

[This message has been edited by Cymy Sue (edited 05-26-2003).]

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Old 05-26-2003, 07:59 PM   #2
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Hi Cymy Sue,
Thanks so much for the post. I am still here. Right now I am on vacation in Arizona just relaxing and clearing my mind before my surgery. I am going home Wednesday, and I have all of my pre-op testing on Thursday. Also on Thursday I will be giving the surgeon a check for 13,000 dollars- just for the actual surgery. The hospital bill will be about 10 thousand. My surgeon has told me that sometimes the insurance will pick up the hospital bill- hopefully this is true for me, but I'm not counting on it..
Yes- I did talk to the Insurance Company. They were getting sick of me- I was calling every day! hehe. The Georgia law states that they cannot deny a surgery for the TMJ if it is medically neccessary. They are following all the laws- they are not denying that my surgery is medically neccesary, they are just saying that they will only pay two thousand dollars.
It is so frustrating because I was waiting for two and a half months for an answer they could have given me the FIRST day I called.
My surgery is June 2nd. I'll be on the computer as soon as I can updating all of you on how it went. I will be staying in the hospital for at least 24 hours- longer if I think I need to or the doctor wants me to.
So anyway, I'll check back in when I get back home. Thanks for the support, I really appreciate it.
"love all, trust a few, do wrong to none."

Old 05-29-2003, 06:47 PM   #3
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I'm back from Arizona.
I had all of my pre-op testing today at the hospital and at the surgeons office. The surgeon had the surgeon that is attending the surgery do a physical on me, and then I went to the hospital where they drew blood, and I talked to a nurse and the anesthesiologist.
I'm getting a little nervous. But I know everything will be ok. I'm trying to eat a lot, because I know I'll be pretty limited in what I can swallow and chew after the surgery.
I'm also nervous about the pain that will accompany the surgery. But, the anesthesiologist assured me that I would be taken care of in that aspect, and the surgeon also said so. He said he'd give me something for the first week, and then something less strong for the next week. It comforts me to know that he will be there for me every step of the way.
Anyway, I just wanted to update everyone. I'm not really reading the board right now. But I promise I will write as soon as I can after the surgery.
I'll be here no matter what, even after I recover and my pain is gone! hehe, wishful thinking.
I hope you are all doing well,
"love all, trust a few, do wrong to none."

Old 05-29-2003, 07:18 PM   #4
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TC543 HB User


I already wrote under the Dr. Benoit thread, but just in case you don't see it...good luck on Monday

[This message has been edited by totallyconfused (edited 10-28-2003).]

Old 05-31-2003, 07:54 PM   #5
Join Date: May 2003
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The problem with getting insurance to pay for TMJ treatment is that it is considered a dental problem. It doesn't matter whether the surgeon is a DDS or MD, the insurance companies list it as a dental procedure. Most insurance companies set their limits for dental procedures back in the late 60's and early 70's and have refused to change them since.

This makes it very difficult to get adequate dental care if you rely solely on what your insurance will pay.

Old 05-31-2003, 08:07 PM   #6
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CherylL24 HB UserCherylL24 HB UserCherylL24 HB User


Not exactly. If you get either dentist/doctor to code it as Myofacial Pain Dysfunction, which is a medical condition, it does get paid for.


Old 06-01-2003, 04:21 PM   #7
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goodwillstacy HB User

Right Cheryl. When I have seen a neurologist for my headaches, it isn't billed as TMJ, it is billed as chronic daily headaches and acute migraines with no aura. That is medical. When I see my pain specialist, it is billed as myofacial pain, and also some discs in my cervical spine are inflamed. That is also medical.
The only time my care gets billed as TMJ, is when I receive a splint, or something like that. Even then it is still billed under medical and seldomly gets refused.
The only thing that has every gotten refused is my huge 25,000 dollar surgery! Go figure. lol.
Anyway I have received some good news that the insurance will be paying for my hospital stay.
I am booked to stay for 23 hours but my doctor and I think I might stay longer. We will see.
Thank you all for your thoughts. I am very lucky to be surrounded with such caring people.
Hope you are all doing well,
"love all, trust a few, do wrong to none."

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